World Journal of Surgery

, Volume 36, Issue 2, pp 232-239

First online:

Development of a Surgical Capacity Index: Opportunities for Assessment and Improvement

  • Steve KwonAffiliated withDepartment of Surgery, University of Washington Email author 
  • , T. Peter KinghamAffiliated withDepartment of Surgery, Memorial Sloan-Kettering Cancer CenterSurgeons OverSeas (SOS)
  • , Thaim B. KamaraAffiliated withDepartment of Surgery, Connaught Hospital
  • , Lawrence ShermanAffiliated withDepartment of Surgery, Firestone Hospital
  • , Eileen NatuzziAffiliated withDepartment of Surgery, Scripps Memorial Hospital
  • , Charles MockAffiliated withDepartment of Surgery, University of Washington
  • , Adam KushnerAffiliated withSurgeons OverSeas (SOS)Department of Surgery, Columbia University

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Significant gaps exist in the provision of surgical care in low- and middle-income countries (LMICs). The purpose of this study was to develop a metric to monitor surgical capacity in LMICs.


The World Health Organization developed a survey called the Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. Using this tool, we developed a surgical capacity scoring index and assessed its usefulness with data from Sierra Leone, Liberia, and the Solomon Islands.


There were data from 10 hospitals in Sierra Leone, 16 hospitals in Liberia, and 9 hospitals in the Solomon Islands. The levels of surgical capacity were created using our scoring index based on a possible 100 points: level 1 for hospitals with <50 points, level 2 with 50–70 points, level 3 with 70–80 points, and level 4 with >80 points. In Sierra Leone, 44% of the hospitals had a surgical capacity rating of level 1, 50% level 2, and 10% level 3. In Liberia, 37.5% of the hospitals had a surgical capacity rating of level 1, 56.3% level 2, and only one hospital level 3. For Sierra Leone and Liberia, two factors—infrastructure and personnel—had the greatest deficits. In the Solomon Islands, 44.4% of the hospitals had their surgical capacity rated at level 1, 22.2% at level 2, 11.1% at level 3, and 22.2% at level 4.


Pending pilot testing for reliability and validity, it appears that a systematic hospital surgical capacity index can identify areas for improvement and provide an objective measure for monitoring changes over time.